Hospitals Race to Meet Jan. 1 Deadline for Major Billing Code Overhaul in Invasive Cardiology and Interventional Radiology, Kodiak Solutions Finds
Hospitals across the U.S. are racing to meet a January 1, 2026, deadline to implement more than 80 new and revised billing codes that affect two of their most financially significant service lines—invasive cardiology (IC) and interventional radiology (IR). According to a new Kodiak Solutions analysis, these two specialties represent nearly 13% of total hospital revenue, underscoring the high stakes of a seamless transition.
The changes stem from the Centers for Medicare & Medicaid Services (CMS), which proposed rule updates in July 2025 as part of the Hospital Outpatient Prospective Payment System (OPPS) and the Physician Fee Schedule (PFS) for calendar year 2026. The finalized physician fee schedule, released October 31, confirmed the sweeping changes—requiring all IC and IR claims to use the new codes beginning January 1, with no grace period for delayed adoption.
Wide-Ranging Coding Updates Affect Hundreds of Procedures
The billing revisions are extensive and will reshape coding protocols for hundreds of cardiac and radiology procedures performed daily in hospitals and outpatient centers.
For invasive cardiology, the new rules include:
- 10 existing codes with updated descriptions or redefined parameters,
- 8 codes eliminated, and
- 2 new codes introduced to reflect evolving procedure definitions and technologies.
For interventional radiology, the changes are even broader, with:
- 16 codes eliminated, and
- 46 new codes added to the system.
In total, hospitals and coding teams must navigate changes among approximately 160 IC codes and 300 IR codes.
These updates may appear administrative on the surface, but they impact how procedures are ordered, documented, coded, billed, and reimbursed,” said Matt Szaflarski, Vice President of Revenue Cycle Intelligence at Kodiak Solutions. “From physicians and coders to revenue cycle teams, these new codes affect clinical, operational, and financial decisions made for scores of procedures each and every day.”
Denials Rising for IC and IR Claims
Kodiak Solutions’ analysis of its proprietary Revenue Cycle Analytics (RCA) platform, which aggregates financial and operational data from more than 2,300 hospitals nationwide, reveals a troubling trend: IC and IR procedures face higher initial denial rates from insurers compared with all other outpatient claims.
The report measures the gross patient service revenue of initially denied claims as a percentage of total revenue for both IC/IR and overall outpatient services. Over the past 12 months, monthly initial denial rates for IC and IR claims were 0.3 to 1.5 percentage points higher than for all outpatient claims combined.
“The data suggest insurers are giving IC and IR claims an incredible amount of scrutiny,” Szaflarski said. “That raises the stakes for hospitals, health systems, and medical providers to properly implement these new codes.”
However, the analysis also shows that final denial rates for IC and IR claims are significantly lower than those for all outpatient claims, suggesting that hospitals eventually overturn many of these initial denials—but only after expending considerable effort.
“Revenue cycle teams have to put in a lot of work to reverse those denials,” Szaflarski explained. “That effort carries real costs, including staff time, administrative overhead, and the cash flow delays that can put financial pressure on hospitals and health systems.”
Financial and Operational Impact
Given that IC and IR account for nearly 13% of hospital revenue on average, failure to comply with the new coding standards—or mishandling denials that result from coding discrepancies—could have an immediate impact on organizations’ bottom lines.
The transition requires not only technical system updates but also coordination across departments, including clinical operations, finance, information systems, and compliance. Missteps could delay claims processing, trigger audits, and cause temporary revenue loss during the first quarter of 2026.
“Coding accuracy isn’t just about reimbursement,” Szaflarski emphasized. “It affects performance benchmarking, payer relationships, and even perceptions of care quality. Hospitals that treat coding as a strategic initiative, rather than a back-office task, are the ones that will navigate this transition most successfully.”
Revenue Cycle and Finance Leaders Take the Lead
Despite the short turnaround time, Szaflarski said increasing denial rates aren’t inevitable—if organizations act quickly and strategically. He outlined several key actions revenue cycle and finance teams should prioritize in the weeks leading up to January 1:
- Launch a coordinated implementation effort.
Build a cross-functional team spanning information technology, clinical documentation, and coding to ensure that all departments are aligned on new definitions, workflows, and charge capture requirements. - Provide targeted training.
Educate physicians, coders, and billing staff on how the new codes affect their specific roles. Clear, scenario-based training can help prevent miscodes that lead to denials. - Review prior authorization and precertification workflows.
Update payer authorization protocols for new codes and establish contingency plans for insurers that may be slow to adopt them. - Monitor performance and denial trends.
Track how new codes are performing by payer and procedure type. Use data to identify recurring denial reasons and address root causes early. - Benchmark key metrics.
Measure performance using indicators such as gross revenue, initial denial rate, denial reversal success, and coding accuracy. Benchmarking data from platforms like Kodiak’s RCA can help hospitals assess how well they’re managing the transition compared to peers.
Preparing for 2026 and Beyond
While the immediate focus is on meeting the January 1 compliance deadline, Szaflarski noted that these coding changes are part of a larger trend toward more granular, data-driven healthcare billing. As CMS continues to refine procedure definitions and expand digital interoperability, hospitals will need to adopt more agile revenue cycle operations that can adapt to frequent regulatory changes.
“Code updates like these are becoming the norm,” Szaflarski said. “Organizations that build continuous improvement processes around coding accuracy and denial prevention will be better prepared for the future.”
Kodiak Solutions plans to continue publishing benchmarking analyses that examine payer behavior, denial trends, and financial performance metrics across service lines. The company’s quarterly Revenue Cycle Analytics Benchmarking Report provides detailed insights into how hospitals can improve compliance, reduce denials, and protect revenue amid changing regulatory requirements.
For more information on the upcoming IC and IR billing code changes and their impact on hospital operations, visit Kodiak Solutions’ Revenue Cycle Analytics Benchmarking portal.
About Kodiak Solutions
Kodiak Solutions is a leading technology and tech-enabled services company that simplifies complex business problems for healthcare provider organizations. For nearly two decades as a part of Crowe LLP, Kodiak created and developed our proprietary net revenue reporting solution, Revenue Cycle Analytics. Kodiak also provides a broad suite of software and services in support of CFOs looking for solutions in financial reporting, reimbursement, revenue cycle, risk and compliance, and unclaimed property. Kodiak’s 450 employees engage with more than 2,300 hospitals and 350,000 practice-based physicians, across all 50 states, and serve as the unclaimed property outsourcing provider of choice for more than 2,000 companies.
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